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Review Question - QID 3938

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QID 3938 (Type "3938" in App Search)
A 25-year-old patient is involved in a motor vehicle accident. An isolated orthopaedic injury is sustained to the upper extremity with no compromise of skin integrity or neurovascular function. A radiograph of the injury is shown in Figure A. The patient is interested in pursuing surgical intervention. What is a reported outcome of surgery when compared to nonoperative management at 1 year postoperatively?
  • A

Increased rates of symptomatic nonunion

3%

155/5103

Similar rates of symptomatic nonunion

8%

410/5103

No differences in cosmetic results

2%

120/5103

Increased functional outcome scores

79%

4045/5103

Improved range of motion of the shoulder

7%

344/5103

  • A

Select Answer to see Preferred Response

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Surgical fixation of this significantly displaced clavicle fracture (greater than 100%) has been associated with greater functional outcomes up to 1 year after injury compared to non-operative measures

Clavicle fractures are often seen in young active patients as the result of falls or direct compressive trauma. Non-operative management of midshaft clavicle fractures is associated with decreased shoulder strength and increased nonunion rates. Risk factors for non-union in non-operative management of midshaft clavicle fractures include advanced age, female gender, displacement and comminution. Open reduction and internal fixation of clavicle fractures is associated with improved results when there is > 2 cm of shortening and 100% displacement.

Zlowodzki et al. retrospectively to compared nonoperative versus operative management of 2144 clavicle fractures. They found that non-operative treatment of displaced midshaft clavicle fractures had a nonunion rate of 15%. Risk of nonunion was reduced by 86% when plating was compared to non-operative measures.

The Canadian Orthopaedic Trauma Society conducted a multicenter prospective study comparing non-operative management versus plate fixation of midshaft clavicle fractures. They found that Constant/DASH scores were significantly improved in the operatively treated group at all time points up to one year of followup. Additionally, a lower rate of nonunion/malunion was identified in the operative group.

Figure A shows an AP radiograph of the clavicle that is significantly shortened and displaced. Illustration A shows a postoperative AP radiograph of the clavicle after open reduction/internal fixation was completed.

Incorrect Answers
Answers 1,2: ORIF is associated with decreased rates of nonunion
Answer 3: ORIF is associated with improved cosmetic results compared to non operative measures
Answer 5: Range of motion after ORIF is comparable to that of non operative treatment

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